Speech disorder in children with Down's syndrome

The speech of children with Down's syndrome (DS) is often unintelligible, unlike many other children who have an intellectual disability. However, the nature of their speech disorder is controversial. The speech error patterns of children with DS were compared to those of intellectually average chil‐dren with phonological disorder whose errors were characterized by inconsistency. The groups were matched for percentages of consonants produced in error. The data revealed no differences between the groups in terms of the number of words which were produced inconsistently on repeated productions in a picture‐naming task. However, further analyses revealed differences in the type of errors made by the groups in that the children with phonological disorder characterized by inconsistent errors made more changes to words on repeated production than the group with DS. The deficits underlying inconsistent pronunciation of words in the two groups of children under investigation would appear to differ. Intervention strategies should target the deficits identified.     

Differential diagnosis of phonological disorder in two bilingual children acquiring Italian and English

The need to differentially diagnose children with speech disorder is widely accepted, although how to do this remains controversial. One differential diagnostic framework proposes four subgroups of speech disorder. Investigating the error patterns of bilingual children will validate the existence of subgroups. The subgroups are differentiated in terms of their surface speech error patterns which are thought to reflect different underlying deficits in the speech processing chain. If this hypothesis is true, then bilingual children with speech disorder should show the same type of speech error patterns in each of their languages. The two case studies reported here describe the error patterns of two bilingual 4 year old children who spoke English and Italian. Their disorders were of unknown aetiology. One child presented with an inconsistent phonological system in both languages. The second child made errors that indicated a delay of her phonological development in both languages. The results of their phonological assessments are discussed in terms of current theories about bilingual development and differential diagnosis of phonological disorders. The study identifies the clinical implications for speech-language pathologists.     

The phonological memory profile of preschool children who make atypical speech sound errors

Previous research indicates that children with speech sound disorders (SSD) have underlying phonological memory deficits. The SSD population, however, is diverse. While children who make consistent atypical speech errors (phonological disorder/PhDis) are known to have executive function deficits in rule abstraction and cognitive flexibility, little is known about their memory profile. Sixteen monolingual preschool children with atypical speech errors (PhDis) were matched individually to age-and-gender peers with typically developing speech (TDS). The two groups were compared on forward recall of familiar words (pointing response), reverse recall of familiar words (pointing response), and reverse recall of digits (spoken response) and a receptive vocabulary task. There were no differences between children with TDS and children with PhDis on forward recall or vocabulary tasks. However, children with TDS significantly outperformed children with PhDis on the two reverse recall tasks. Findings suggest that atypical speech errors are associated with impaired phonological working memory, implicating executive function impairment in specific subtypes of SSD.     

Abnormal pinna type and hearing loss correlations in Down's syndrome

ABSTRACT. Significant hearing loss and external pinna malformations are two of the most common defects evident in Down's syndrome. The external and middle ears are linked embryologically, both arising from the first and second branchial arches. Evidence indicates that the majority of hearing loss in Down's syndrome is conductive in nature, originating from malformations of the middle ear ossicles and/or the eustachian tube. Recent studies also have indicated that hearing loss is a contributing factor to the IQ and learning deficits that afflict most individuals with Down's syndrome. Therefore, an early, external diagnostic feature for predicting conductive hearing loss would be desirable. In the current study, people with Down's syndrome, people with non-Down's mental retardation and control subjects were examined in a clinical environment for the presence of hearing loss and pinna defects. It was found that 90% of the Down's syndrome population had significant hearing loss, compared to slightly more than 50% in the non-Down's group and no hearing loss in the controls. Also, the majority of hearing loss among individuals with Down's syndrome was conductive, while all hearing loss in the non-Down's group was sensorineural The Down's syndrome population exhibited nearly 3.5 pinna defects per ear, with malformations of the helix being very evident. The non-Down's population exhibited 2.5 pinna defects per ear, with concha defects being the most common.     

Multilingual English-Mandarin-Malay phonological error patterns: An initial cross-sectional study of 2 to 4 years old Malaysian Chinese children

Child multilingual phonological errors are under-explored. Cross-linguistic studies suggest monolingual children make phonological errors that are subject to effects of language universality and ambient language characteristics. Bilingual Chinese children were observed to use not only typical, but also atypical phonological errors compared to monolingual peers acquiring similar languages. Atypical errors are a result of specific bilingual pair effects. Close-language-relatedness (Cantonese-Mandarin) is claimed to be responsible for the nonexistence of atypical errors in both languages, whilst distant-language-relatedness (Cantonese-English) is observed to cause atypical errors in both languages. The present novel cross-sectional study investigated phonological acquisition in three typologically distant languages: English-Mandarin-Malay by 64 multilingual Chinese children aged 2½-4½. The present research aimed to explore if multilingual Chinese children exhibit phonological errors which commensurate to that of monolingual and bilingual Chinese children acquiring similar languages as described in the literature. The single-word phonological test results revealed that the multilinguals exhibited typical and atypical phonological patterns which largely commensurate with the monolinguals and bilinguals. Similar to bilingual children, the multilingual children showed more atypical errors in English than in Mandarin, demonstrating effects of individual language irrespective of potential interaction with additional languages. The present result did not fully support the link between closeness in typology of languages and the absence of atypical errors. Rare atypical errors were found in Mandarin and Malay, two typologically different languages, and both were also interacting with English, another typologically different language. The present findings provided useful preliminary multilingual speech norms for the use of speech therapists.     

Performance of persons with Down's syndrome on two projective techniques.

A comparison was made of the Rorschach responses and the Human Figure Drawings of a group of 21 Down's syndrome subjects and the responses of a group of 21 other mentally retarded persons (non-Down's syndrome group). Statistically significant differences on the Rorschach were indicative of a better differentiated visual perceptual ability in the Down's syndrome group. The traditional stereotype of the person with Down's syndrome as having a better self-concept and being more affectionate and cooperative was supported by the Rorschach results. This was not substantiated by the Human Figure Drawings, in which the non-Down's syndrome group performed significantly better than the Down's syndrome group.     

Putonghua (modern standard Chinese)-speaking children with speech disorder

Developmental speech disorder affects up to 10% of the pre-school English-speaking population. However, speech disorder in Putonghua or Modern Standard Chinese (MSC)-speaking children has not been described. In this study the phonological systems of 33 Putonghua-speaking children with speech disorder were described. Quantitative measures (severity; inconsistency) as well as qualitative measures (phonetic and phonemic inventories; phonological processes) were presented. Of the 33 children, one child had articulation disorder, 18 had delayed phonological development, eight consistently used unusual error patterns, and six children's speech was characterized by inconsistency of production. The findings provided further cross-linguistic support for the 'four subgroup categorization system' (Dodd, 1993). The phonological systems of the Putonghua-speaking children with speech disorder were compared to those of normally developing children and those of children with speech disorder from other language backgrounds. Similar to normally developing children, Putonghua-speaking children with speech disorder were sensitive to the structure of the ambient language. They also shared the characteristics common to disordered children speaking other languages, such as persisting delayed processes, unusual error patterns, variability, restricted phonetic or phonemic inventory, and systematic sound or syllable preference.     

Articulation or phonology? Evidence from longitudinal error data

Children’s speech difficulties can be motor (phone misarticulation) or linguistic (impaired knowledge of phonological contrasts and constraints). These two difficulties sometimes co-occur. This paper reports longitudinal data from the Early Language in Victoria Study (ELVS) at 4 and 7 years of age. Of 1494 participants, 93 made non-age appropriate speech errors on standardised assessments at 4 years, and were able to be reassessed at 7 years. At 4 years, 85% of these children only made phonological errors, 14% made both articulation and phonological errors and one child only made articulation errors (a lateral lisp). In total, 8 of 13 children making both articulation and phonological errors at 4 years had resolved by 7 years. Unexpectedly, eight children who had demonstrated articulation of fricatives at 4 years, acquired distorted production of ≥ 50% of occurrences of/s, z/ by 7 years. In total, then, 22 children (24% of children with speech difficulties) made articulatory errors at one or both assessments. Case data for all children are presented. Theoretical and clinical implications are considered.     

Down's syndrome and leukemia: mechanism of additional chromosomal abnormalities.

There is an increased incidence of acute leukemia in patients with Down's syndrome patients have a trisomy-21 chromosomal pattern, and chromosomal abnormalities can be seen in acute leukemia. It is possible that the increased incidence of acute leukemia in Down's syndrome persons may be due in part to their chromosomal abnormalities. Such abnormalities, some appearing in a stepwise clonal evolution, were found in five Down's syndrome patients, four with acute leukemia and one with abnormal regulation of leukopoiesis. Morphological abnormal chromosomes were also found in three patients. These chromosomal abnormalities are similar to those seen in non-Down's syndrome leukemic patients. There is suggestive evidence for clonal evolution hypothesis of luekemogenesis in non-Down's syndrome patients. The abnormal chromosomal pattern reported in our Down's syndrome patients could be the result of nondisjunction in mitosis, and leukemia may be the phenotypical expression of this nondisjunction.     

Speech errors in Cantonese speaking adults with cerebral palsy

The aim of this study was to characterize the speech errors made by Cantonese-speaking adults with dysarthria associated with cerebral palsy, using a perceptual-phonetic analysis. The subjects were 22 adult Cantonese speakers with cerebral palsy. Fifteen subjects had spastic-type cerebral palsy, five had athetoid-type and two mixed-type. Single words were transcribed phonetically and analysed by speech part for accuracy and error patterns. There were no significant differences in accuracy for type of cerebral palsy, gender or age. Speakers with athetosis had a significantly higher relative occurrence of diphthong reduction. The majority of error patterns could be explained by the neurological damage of cerebral palsy. However, several patterns were attributed to unique features of the Cantonese phonological system. Physiological explanations and language-specific contributions to speech disorder in this group of speakers were discussed.     

Validation of the Intelligibility in Context Scale as a screening tool for preschoolers in Hong Kong

The Intelligibility in Context Scale (ICS) is a parent report questionnaire for assessing children’s speech intelligibility. The original version was developed in English and was based on Environmental Factors identified within the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). The ICS has been translated into over 30 languages, including Traditional Chinese (ICS-TC). The aims of the current study were to examine the psychometric properties of the ICS-TC with Cantonese-speaking parent--child dyads and to identify speech measures that were more sensitive to the ICS-TC ratings. A total of 72 Cantonese-speaking preschoolers with (n?=?39) and without speech sound disorders (SSD; n?=?33) were recruited. Native Cantonese-speaking parents completed the ICS-TC independently. The measure showed good internal consistency and test–retest reliability. Correlations with speech performance on the Hong Kong Cantonese Articulation Test (HKCAT), and significant difference in ICS-TC mean scores between the two groups provided preliminary support for the validity of ICS-TC and suggested that ICS-TC can differentiate between children with and without SSD with a large effect size of d?=?0.74. The optimal cutoff was estimated using Receiver Operative Characteristic (ROC) curve analysis, giving a sensitivity of 0.70 and specificity of 0.59. ICS-TC mean scores showed a positive correlation with the percentage of initial consonants correct and negative correlation with frequency of atypical errors, and both were moderate in strength. Given the satisfactory psychometric properties of ICS-TC, it may be a valuable clinical tool for screening Cantonese-speaking preschool children’s intelligibility.     

Development and change in the phonology of Putonghua-speaking children with speech difficulties

The speech error patterns of seven Putonghua-speaking children with speech difficulties, who received no clinical intervention, were assessed twice over an interval of about 11 months. Qualitative measures (phonetic inventory, phonemic inventory, and phonological process use) and quantitative measures (severity score and inconsistency rating) were used. One child's phonology was within normal limits initially, but showed characteristics of delayed development at the second assessment. Of the three children presented with delayed acquisition at the initial assessment, one child had attained age-appropriate phonology at the second assessment, while the other two children remained delayed. Two children who consistently used phonological error patterns atypical of normal development and one child whose speech was characterized by inconsistency showed little change in the number and type of errors made. The theoretical and clinical implications of these results are discussed. It is argued that children with different underlying deficits might follow different paths of development. Delayed phonological development may occur at any stage of children's phonological acquisition and spontaneously resolve later, while disordered phonological development may start at speech onset and be resistant to changes, due to deficits in the speech processing chain. The data support the need for differential diagnosis and treatment of children with speech disorders.     

An investigation of phonological skills in Puerto Rican Spanish-speaking 2-year-olds

Researchers have been interested in separating common cross-linguistic phonological patterns (so-called 'universals') from language-specific ones. Previous studies typically have focused on a relatively small number of patterns (e.g., substitution patterns for target liquids, deletion patterns for clusters). The purpose of this study is to describe phonological skills of three Puerto Rican, Spanish-speaking 2-year-olds and to determine which patterns tend to be specific to Spanish and which ones are also exhibited commonly by speakers of a variety of languages. The study of Spanish represents an opportunity to continue examining a language that has a different ambient phonology and comes from a different language family than the languages examined in other studies of 2-year-olds: English, Cantonese and Igbo. Three monolingual, Spanish-speaking 2-year-olds living in Puerto Rico participated in the study. Independent and relational analyses of both consonants and vowels were conducted on the children's connected speech samples. Comparisons were then made to phonological profiles of other Spanish-speaking 2-year-olds and to 2-year-olds speaking languages other than Spanish. The results indicated that the Puerto Rican, Spanish-speaking children exhibited phonological skills that were both comparable to and divergent from those exhibited by 2-year-old speakers of other languages.     

The effect of context on mother's interaction style with Down's syndrome and typically developing children

Several studies suggest that difficulties with production or comprehension of language might be associated with the number of interactions initiated by parent or child, responsiveness or ability to sustain ongoing interactional sequences, or the distribution of parental interaction, control and reinforcement strategies. In this study Down's syndrome and typically developing preschool children were observed interacting with their mothers in free play and mealtime settings. We expected interaction patterns in the mothers of Down's syndrome children to be different from those in the mothers of typically developing children. Sixteen mother-child dyads (eight with Down's syndrome children and eight with typically developing children) served as subjects. Mothers of Down's syndrome children use more teacher and helper behaviors, particularly in meal time context, and less positive verbalizations than the mothers of typically developing children. Down's syndrome children also showed higher frequency of eye gazes during mealtime context. Patterns of such differences are discussed in terms of how mothers' style interactions during home activities might be differentially affected by different types of parent training interventions.     

Phonological mean length of utterance in specific language impairment: a multi-case study of children acquiring Finnish

This study assesses the phonological development of four Finnish-speaking children (ages 4;8, 4;9, 4;9 and 5;5) with specific language impairment (SLI) and dyspractic features in speech. The analysis is performed using the phonological mean length of utterance (pMLU) method. Moreover, the children's phonological abilities are evaluated qualitatively in relation to segments, phonotactics and word structure. The results are compared with those obtained from four age-matched typically developing peers and with the data from an earlier study using the pMLU method on younger, typically developing Finnish children. In the pMLU analysis, the children with SLI performed roughly at the level of typically developing 2-year-old children. The qualitative analyses revealed that children with SLI had difficulties in producing word-medial clusters and word-initial consonants and that they exhibited frequent consonant assimilations, infrequent errors and vowel errors. The pMLU method did differentiate between children with SLI and typically developing children. However, qualitative analyses revealed some weaknesses of the pMLU method when assessing Finnish children with SLI.     

Phonological mean length of utterance in specific language impairment: a multi-case study of children acquiring Finnish

This study assesses the phonological development of four Finnish-speaking children (ages 4;8, 4;9, 4;9 and 5;5) with specific language impairment (SLI) and dyspractic features in speech. The analysis is performed using the phonological mean length of utterance (pMLU) method. Moreover, the children's phonological abilities are evaluated qualitatively in relation to segments, phonotactics and word structure. The results are compared with those obtained from four age-matched typically developing peers and with the data from an earlier study using the pMLU method on younger, typically developing Finnish children. In the pMLU analysis, the children with SLI performed roughly at the level of typically developing 2-year-old children. The qualitative analyses revealed that children with SLI had difficulties in producing word-medial clusters and word-initial consonants and that they exhibited frequent consonant assimilations, infrequent errors and vowel errors. The pMLU method did differentiate between children with SLI and typically developing children. However, qualitative analyses revealed some weaknesses of the pMLU method when assessing Finnish children with SLI.     

Effect of dialect on phonological analysis

It is important to understand a child’s language background, to ensure appropriate assessment, diagnosis and treatment of speech sound disorders. Singapore is home to various cultures and languages, and local speech norms are needed to provide an accurate reference for assessing phonological disorders in the local population. This study aims to establish normative data and better understand the English phonological development of English–Mandarin bilingual preschoolers in Singapore, aged 3; 6–4; 5 years. The Articulation and Phonology subtests of the Diagnostic Evaluation of Articulation and Phonology – UK were used to collect speech data from 146 preschoolers. Responses were scored against two standards – British Standard English (BSE) and Singapore English (SGE), in terms of speech sound accuracy, and the frequency and type of error patterns present. The effect of language dominance on the children’s English phonological abilities was explored. Results showed that the preschoolers’ speech sound accuracy increased significantly when scored against SGE versus BSE targets. The number of children identified to be using several error patterns was reduced when SGE targets were used instead of BSE targets. English-dominant children scored significantly higher than their Mandarin-dominant peers on measures of speech sound accuracy. The identification of error patterns also differed between the two groups. These results show that it is important to take dialectal variation and language dominance into account in assessment, to determine if speech characteristics are due to a speech sound disorder or just normal dialectal variations.     

Low-level neural auditory discrimination dysfunctions in specific language impairment—A review on mismatch negativity findings

In specific language impairment (SLI), there is a delay in the child’s oral language skills when compared with nonverbal cognitive abilities. The problems typically relate to phonological and morphological processing and word learning. This article reviews studies which have used mismatch negativity (MMN) in investigating low-level neural auditory dysfunctions in this disorder. With MMN, it is possible to tap the accuracy of neural sound discrimination and sensory memory functions. These studies have found smaller response amplitudes and longer latencies for speech and non-speech sound changes in children with SLI than in typically developing children, suggesting impaired and slow auditory discrimination in SLI. Furthermore, they suggest shortened sensory memory duration and vulnerability of the sensory memory to masking effects. Importantly, some studies reported associations between MMN parameters and language test measures. In addition, it was found that language intervention can influence the abnormal MMN in children with SLI, enhancing its amplitude. These results suggest that the MMN can shed light on the neural basis of various auditory and memory impairments in SLI, which are likely to influence speech perception.